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Do we have a right to die on our own terms?

Do we have a right to die on our own terms?

Dudley Clendenin, the elegant stylist who was once a national correspondent for The New York Times writes of his impending death:

I am acutely lucky in my family and friends, and in my daughter, my work and my life. But I have amyotrophic lateral sclerosis, or A.L.S., more kindly known as Lou Gehrig’s disease, for the great Yankee hitter and first baseman who was told he had it in 1939, accepted the verdict with such famous grace, and died less than two years later. He was almost 38.

I sometimes call it Lou, in his honor, and because the familiar feels less threatening. But it is not a kind disease. The nerves and muscles pulse and twitch, and progressively, they die. From the outside, it looks like the ripple of piano keys in the muscles under my skin. From the inside, it feels like anxious butterflies, trying to get out. It starts in the hands and feet and works its way up and in, or it begins in the muscles of the mouth and throat and chest and abdomen, and works its way down and out. The second way is called bulbar, and that’s the way it is with me. We don’t live as long, because it affects our ability to breathe early on, and it just gets worse.

He plans to end his life before the disease robs him of his his ability to live it with dignity:

I’d rather die. I respect the wishes of people who want to live as long as they can. But I would like the same respect for those of us who decide — rationally — not to. I’ve done my homework. I have a plan. If I get pneumonia, I’ll let it snuff me out. If not, there are those other ways. I just have to act while my hands still work: the gun, narcotics, sharp blades, a plastic bag, a fast car, over-the-counter drugs, oleander tea (the polite Southern way), carbon monoxide, even helium. That would give me a really funny voice at the end.

I have found the way. Not a gun. A way that’s quiet and calm.

Clendenin, an Episcopalian who lives in Baltimore, writes with such easy grace, and his attitude toward his death is so matter-of-fact that one can glide faster than one should past the fact that he is planning to kill himself. This is a thorny issue. Do you agree with his decision?

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Judith Crossett

I have had two family members take their own lives; one with terminal medical illness and no hospice/palliative care/DNR available; the other thought his (emotional, personal) life had ended. Clearly the decision to end life at any time is the hardest imaginable. I can support, pray, love, but I cannot tell anyone what they can or should or might do. And I recognize that my stance here--that I can't tell anyone, any decision, what to do or that I think they're right or wrong--means that at some level I'm leaving that person more alone.

Ironically, perhaps, I am a psychiatrist by profession, so deal with suicidal people frequently. We (conveniently) don't regard psychiatric patients as "rational suicides", so we can tell them they shouldn't go through with it, they should get help, etc. We help, some, but there is a lot of pain in psychiatric illness we help very imperfectly.

Loving God, help us all to heal.

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Execute

I find myself ambivalent in these situations. In part, that's because I was in Detroit as Jack Kevorkian was active. One morning I read of one of his (what word shall we wrestle with? Patients? Victims?) clients and saw the name of a physician I had worked with some years before.

Benedict, I also work in healthcare chaplaincy, and I often find that it is precisely because of the "indiminishable human being in question" that in fact we do ethics at the bedside, and assist personal decisions, if not policy decisions. I don't think we're in disagreement. Rather, I'm noting that the important decisions in biomedical ethics aren't policy decisions, but the personal decisions of each patient.

I certainly agree that every person must be responsible for his or her own decisions, and, especially about care at the end of life, should discuss those in detail with loved ones. At the same time, precisely because we live networked in families and communities, I don't think we can make light of the Christian tradition that suicide isn't preferable.

Marshall Scott

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Benedict Varnum

Jim, the language I found provocative in your first post was "glide faster than one should past the fact that he is planning to kill himself."

One thing that I felt you were pointing to is the previously un-challenged position in many Christian groups that "suicide" is never acceptable. Stories like this are challenges to that.

There's a principle in biomedical ethics that you don't make policy decisions at bedside; it's impossible to get past the indiminishable human being in question. Similarly here, I think it's impossible to wrestle with our theology in the abstract next to Dudley's story.

As someone who currently works in health care chaplaincy, I cannot agree enough with Laura Toepfer's suggestion that every person talk to friends, partners, and family members about what they'd want their end-of-life care to look like.

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LKT

Perhaps the question is, if you were in this position, what do you think you would you choose to do and why? What would inform that decision?

Another question is, How have you prepared for end of life decisions? Have you discussed with your loved ones (much less the world) your desires for what level of treatment you wish to receive should you be critically ill?

Laura Toepfer

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Jim Naughton

Dennis, perhaps you have a point. I might better have written What are your feelings about end of life issues? Perhaps you'd like ot suggest other language.

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